Loading...
HomeMy WebLinkAbout2025-00068868 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I0110 II II III II III DO IOU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 050915 u, 1 U21 2 4 2 UI 2 U2 2 U, 1 1_12 1 U1 1 U2 1 5 15 u1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ❑OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 2025I 2025-00068868 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 "I S CRYSTAL AVE El In05:44 ® ❑ RELATED ®Y 0 N 10 21 2025 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION ITI FT!MI N E S W W CHICAGO ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (/)❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGED AREA(S) FROPtf TOWED U1 Q Boydston. Megan.A. 0 8 / yr 13-UNDER CARRIAGE I '._Z ©, STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 0 (Il F 2 4 SYTM❑Y ®S NE DUNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN - r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iL 6 I, 4 COM VEH 0 E! 3 0 ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *Ilves.See Sidebar U1 Z ZV50057 IL 2026 REAR TELEPHONE IL D 0 JTEBU14R240049486 StateFarm ®v ❑N U2 M 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Boydston.Gary, E. 0911167SFP13 2 o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER r RESPONDER '1 9 9 5 Honda Accord 2007 00-NONE ,�_"I Q� O DUETOCRASH ❑ 2 xj o 13-UNDER CARRIAGE 10) I.. 2 FIRE 0 ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i 6 i.!.,_4 COM VEH ❑ ® u1 W FIRST CONTACT 1 7 _,__5 C.If Yes.See Sidebar C ELGIN IL 60123 0 1 0 EC77145 IL 2026 g (p IL D 0 1 HGCM56797A036326 Unique Insurance Company ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Abreu Uzcategui,Jesus,A. ILP2815026 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP U1 = (UNIT) (SEAT) (DM (SEX) {SART) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 6 02 / ' D / / 3 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 10/21 /2025 05 44 ®pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 6 C1 T 2 0 2 18 / / ❑PM• 0 Construction o " 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 8 ❑AM 0 Maintenance U2 o1 ® 11 4 ARREST NAME Gomez Colmenarez, Majholy,J. 12-503-A-5 W1530000512 / / El PM SLMT o N • 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE• TIME El Utility F 2 ❑ ARREST NAME AM T / / pM 0 Unknown work zone type 15 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - 0 AM Workers present? ❑Y 15 1530-Soto.Oscar 601 / / ❑PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , N 1 - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 0 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< - }____r____1 INDICATE NORTH combination):or -I p1 Not To Scale 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - i. e. (example:shuttle or charter bus):or X < <-----;-•-•; Unit 1 - } } } transportinggemployees lloo aeeslin the course 5 or fewer passengers ttheir employment ma tod operated by a contract:employee carrier I O I1 transportr-usually a van type vehicle or passenger car)(orxample: L ----------; II - • } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C ( Iu (I for direct compensation(example:large van used for specific purpose):or Le— o -I- -I ! 1 _ � � � t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m lipplacarding(example:placards will be isplayed on the vehicle). ;p W?Chicago?St _ 1 > Unit 2 CARRIER NAME Z ADDRESS 0 I O CITY/STATE/ZIP C) MOTOR CARR.ID 0 Interstate 0 Intrastate rt r 1 • ❑ Not in Comm./Govt. Not in Comm./Other0 USDOT NO. ILCC NO. S?Crystal?Ave XI Source of above z ' . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE